Low CAHPS scores? Try this

Ratings are an important tool in ensuring accountability among health plans, but plans are often left with vague scores that offer little information on how to improve ratings and patient outcomes.

One solution is to perform additional surveys that delve deeper into why plan members choose the scores they do when it comes to surveys like the Consumer Assessment of Healthcare Providers and Systems (CAHPS). These deeper, “drill down” surveys were the focus of one of the opening sessions at Qualipalooza, the second annual RISE quality leadership summit in San Antonio, Texas, June 29 to 30.

The session, “Improving CAHPS with Drill-Down and Simulation Surveys,” brought together stakeholders who conduct and those who commission drill down surveys to highlight how they can help health plans close gaps in care.

Linda M. Lynch, MEd, PRC, performance improvement consultant for SPH Analytics, led the session and says most health plans are required to do CAHPS surveys by CMS or other organizations.

These surveys provide valuable information about how a health plan is performing, and are used to assign ratings that can impact reimbursements, bonuses, and perceptions about the health plan. Low ratings can be a sign that there are gaps in care, but don’t give detailed information on ways to close those gaps.

“The problem with the surveys is that they don’t provide much about the why, especially when it’s unfavorable,” Lynch says, explaining that plans will sometimes just take a shot in the dark when it comes to making improvements. “But the most efficient thing to do is to ask members. By doing a CAHPS Drill Down survey, plans can find out the whys behind a low health plan rating, or what are the problems in getting access to care that members are encountering.”

This allows the plan and the providers to get on the same page and make changes more efficiently by dealing with bonafide shortcomings as opposed to guessing at what changes should be made.

Christina Latterell, vice president of quality improvement at Alignment Healthcare, co-presented with Lynch and says doing drill down surveys helped the plan address specific shortcomings.

“We were able to have detailed conversations about the measures through provider roadshows. We talked about outcomes and implemented best practices and action plans,” Latterell says.

The surveys uncovered issues such as staffing problems at offices, or problems members have with location or transportation to get to appointments.

David Larsen, RN, MHA, director of quality improvement at SelectHealth, says drill down surveys helped his plan find out what were the driving forces behind the CAHPS scores they received, what were the barriers that led to lower scores, and how the plan could improve.

“In past years, we would get CAHPS results and have a view of member perception of our services but then not know what to do about it,” Larsen says. “You might guess, but a drill down survey allows you to ask additional questions regarding the CAHPS questions and put action plans into place.”

For SelectHealth, drill down surveys oversample, doubling the population polled by the CAHPS survey. The surveys have lead to improvement in areas like pharmaceutical education, Larsen says. Drug questions were a frequent source of member dissatisfaction, and the survey results led the plan to redesign its drug education materials so that members can understand pharmaceutical coverage in easy-to-understand language.
“We are trying to educate patients before they get to the pharmacy window,” Larsen says.

They’ve also focused on physician education based on member satisfaction scores, claims turnaround time, and a member communication portal that allows them to tell the plan how they would like to be reached.

“Some people look at the CAHPS scores and say these are impossible to improve on so we’re just going to ignore them or do a few things that we think are going to work,” Larsen says. “They’re kind of guessing, and lots of times they end up doing things that are not helpful because they’re not focusing on the real issues.”

Although it takes some time to find out if efforts translate to improvements in CAHPS scores, internal polling has been promising.

Alignment conducted three different waves of surveys, and the raw data has shown improvement over the previous year. Only the next CAHPS survey will tell for sure if their efforts have been productive, but early estimates show an increase equivalent to improvement on several independent Star measure ratings, Latterell says.

Latterell says she hopes those who attended the session will take some of these ideas and best practices back with them to effect positive changes for their patient populations.

While plans could try and survey members on their own, many health plans don’t have the staffing, resources, or expertise to take on such surveys in house, Lynch says. In these cases, outside vendors like SPH Analytics can be used. Lynch also advises plans to think carefully about what they want the surveys to tell them.

“It’s really good if they develop a set of objectives internally before starting a survey,” she says. “What do they want to learn and what do they want to accomplish? You really need to have a thorough planning process so that you end up with a better survey and better survey results.”